免氣腹腔鏡子宮全切術(shù)后陰道殘端懸吊在臨床的意義

羅迎春+于江+鐘俊妍+唐玲玲

【中圖分類號(hào)】R734.6 【文獻(xiàn)標(biāo)識(shí)碼】A 【文章編號(hào)】2095-6851（2016）11-0-01

【Abstract】Objective To investigate the superiority of using the vaginal stump suspension after gasless laparoscopic hysterectomy to prevent the vaginal stump prolapse after surgery. Methods from September 2014 to September 2015，168 patients who needed gasless laparoscopic hysterectomy in our hospital were divided into two groups， 88 patients from Group A had been operated on using vaginal stump suspension after gasless laparoscopic hysterectomy， and 80 patients from Group B had been operated on using vaginal stump suspension without gasless laparoscopic hysterectomy. Results The two groups in operation time， blood loss， hospital stay after operation， postoperative anal exhaust time， active time post-operation， postoperative pain have no significant difference （P>0.05）. And there are significant differences between the two groups at the postoperative vaginal length changes，including the time after operation， three months after operation and six months after operation，and sexual life satisfaction score （P<0.05）. Conclusion The gasless laparoscopic hysterectomy vaginal stump after suspension can prevent postoperative vaginal stump prolapse， and is simple， safe and reliable.

【Key words】Gas free laparoscopic Total hysterectomy the vaginal stump suspension

隨著子宮切除的廣泛應(yīng)用，醫(yī)源性因素作為盆腔器官脫垂（pop）的致病因素逐漸受到重視[1]，根據(jù)美國(guó)衛(wèi)生統(tǒng)計(jì)中心（AHSC）的報(bào)告，每21例子宮切除術(shù)就有1例發(fā)生陰道穹隆脫垂，而每11例子宮切除就會(huì)有1例將來(lái)需要行陰道頂端懸吊術(shù)和陰道封閉術(shù)[2]，本院對(duì)免氣腹腔鏡子宮全切術(shù)后的168例患者隨機(jī)分成兩組，88例（A組）進(jìn)行免氣腹腔鏡子宮全切加陰道殘端懸吊，對(duì)照組80例（B組）施行免氣腹腔鏡子宮全切，取得滿意效果，現(xiàn)報(bào)道如下：

1.臨床資料

1.1觀察對(duì)象對(duì)2014年9月至2015年9月在我院行免氣腹腔鏡子宮全切術(shù)后的168例患者隨機(jī)分成兩組，88例（A組）進(jìn)行免氣腹腔鏡子宮全切加陰道殘端懸吊，對(duì)照組80例（B組）施行免氣腹腔鏡子宮全切，A組其中子宮肌瘤42例，子宮腺肌癥32例，功能失調(diào)性子宮出血8例，子宮內(nèi)膜不典型增生6例，行子宮全切及雙側(cè)輸卵管切除66例，子宮及雙側(cè)附件切除術(shù)22例，B組其中子宮肌瘤41例，子宮腺肌癥28例，功能失調(diào)性子宮出血6例，子宮內(nèi)膜不典型增生5例，行子宮全切及雙側(cè)輸卵管切除60例，子宮及雙側(cè)附件切除術(shù)20例，患者年齡在47-58歲之間，平均年齡48.47歲，體重47kg-74kg，平均體重58..85kg?；颊吣挲g、病種，手術(shù)史及腫瘤大小均無(wú)明顯差異，兩組患者選擇無(wú)明顯差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）.術(shù)前患者常規(guī)行陰道鏡檢查及宮頸細(xì)胞學(xué)檢查，查癌胚抗原，所有患者排除嚴(yán)重的心肺肝腎病變及婦科惡性腫瘤，

1.2手術(shù)方法：

1.2.1麻醉與體位 均采用腰麻+連續(xù)硬膜外麻醉+靜脈復(fù)合麻，所有患者頭低臀高（約15-20度）臀部超出手術(shù)臺(tái)5-10cm左右?！?br>